Management of atypical and low-grade cervical cytology

The finding of atypical and low-grade cervical cytology on routine Papanicolaou test is considered problematic for gynecologists and pathologists. The interpretation and management of these cases can be difficult when Papanicolaou test results fall into the Bethesda 2001 categories of atypical squamous cells, atypical squamous cells--cannot rule out high-grade, atypical glandular cells, or low-grade squamous intraepithelial lesion. Although liquid-based Papanicolaou tests may have resulted in some improvement in detection, a large amount of variability in cytologic interpretations continues to exist. The recent approval of concurrent use of high-risk human papillomavirus DNA testing with cytology in the screening of women for cervical neoplasia adds a new dilemma to patient management: What should we do with women who are positive for high-risk human papillomavirus DNA but have negative cervical cytologic results?